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  • • Decompression of the upper gastrointestinal tract (eg, pancreatitis, intestinal obstruction).

    • Gastric lavage.

    • Enteral feeding.

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Absolute

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  • • Unstable airway.

    • Intestinal perforation.

    • Cervical spine trauma.

    • Facial trauma.

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Relative

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  • • Coagulopathy (prothrombin time > 18 seconds).

    • Thrombocytopenia (platelet count < 100,000/mcL).

    • Recent intestinal tract surgery (< 1 month ago).

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  • • Lubricant gel.

    • Nasogastric (NG) tube.

    • • Larger diameter, polyethylene NG tube for suction and decompression.

      • Smaller diameter, silicone NG tube for enteral feeding.

    • Water or normal saline at room temperature.

    • Drainage bag or feeding pump.

    • 60-mL catheter tip syringe.

    • Stethoscope.

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  • • Bleeding.

    • Perforation.

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  • • Measure length of tube insertion by positioning the tube from the nares or mouth to the ear, then to the umbilicus.

    • There is also a standard table, which uses height of child.

    • If the tube is obstructed, flush first with water; longstanding obstruction may be removed by flushing the tube with caffeinated soda.

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  • • Explain indication and risks to the patient and parents.

    • Inform the patient of the intention of the procedure.

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  • • Patient should be sitting.

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  • • Tube position from the nose to the stomach.

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  • • Measure the length of insertion from the nares to the ear and to the epigastrium (Figure 25–1); mark it on the tube with an indelible pen.

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  • • Lubricate tube with gel.

    • Insert the tube through the nose (Figure 25–2).

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  • • Ask the patient to cooperate by swallowing while the tube is being inserted.

    • Advance the tube to the length mark.

    • To check position, aspirate tube with 50-mL syringe (Figure 25–3); gastric aspirate (pH = 1–3) confirms positioning in stomach.

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  • • Insert small amount of air (20–30 mL) via NG tube while listening to epigastric area of stomach with stethoscope.

    • If unsure about tube placement, verify tube position by obtaining a chest film before starting enteral feeding or drug treatment.

    • Secure tube to the face with tape.

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Figure 25–1.
Graphic Jump Location

Measuring the length of tube for insertion.

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Figure 25–3.
Graphic Jump Location

Checking the position of the tube.

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  • • Monitor intake and output volume.

    • Evaluate tube position.

    • Patient symptoms.

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  • • Aspiration.

    • Infection.

    • Sinusitis (caused by long-term NG tube feeding).

    • Bleeding.

    • Perforation.

    • Mucosal tears.

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  • • Call a doctor when any of the following clinical signs are present:

    • • Fever.

      • Nausea and vomiting.

      • Melanotic stool or bright red hematemesis.

      • Persistent abdominal pain.

      • Abdominal distention.

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